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FLUORIDATION AND THE COUNCILLORS
1104
SERUM-VITAMIN-B12 AND CHLORPROMAZINE SIR,-Dr. Herbert (March 5), in criticising our determinations of serum-vitamin-B12 levels in patients before and after chlorpromazine therapy, suggests " that before the second vitamin-B12 determination the patients had been off large doses of chlorpromazine for a week ". Chlorpromazine treatment was not stopped before the second assay. We have also studied patients treated with high doses of chlorpromazine for years. Their serum-vitamin-B12 values were not low. We have established with reasonable certainty that chlorpromazine in usual doses does not inhibit the growth of Euglena alga. Nor does chlorpromazine suppress the growth of Lactobacillus leichmannii, as shown by Dr. Forshaw and Miss Harwood (March 12). Dr. Herbert implies that our patients were inadequately examined, and states that we did not find structural hsematopoietic damage in a single case. He could easily have seen from our original paper1 how many of our patients with low vitamin-B12 values had hypersegmentation, anisocytosis, and glossitis, and changes of Hb, erythrocyte-sedimentation rate, mean corpuscular haemoglobin, red-cell count, serum-iron, gastric juice, Schilling test, bone-marrow, and neurological status. Good correlation was found with the Schilling test, and some of the other tests were also positive. The vitamin-B12 assay, however, was the only test which allowed us to pick out these patients immediately.
St.
Joseph’s Hospital, Porsgrunn, Norway.
E. EDWIN K. HOLTEN K. R. NORUM A. SCHRUMPF O. E. SKAUG.
TETRACYCLINES AND THE TEETH SiR,—The fact that discoloration of teeth can result from tetracycline medication during the period of crown formation has now been widely reported, and as your leading article (April 23) points out this fact should be borne in mind when choosing an antibiotic for children up to about 7 years old. Nevertheless it seems important to maintain a sense of proportion in this matter and not to prejudice the practitioner against these drugs unjustifiably. During the past 4 years I have used tetracyclines as a bonelabel in the study of bone activity and growth in animals. The level of medication has been similar to that of the 4-5-day therapeutic human adult dose and at this level there have been little if any macroscopic signs of pigmentation, although the label is clearly visible in sections of enamel and dentine when viewed under ultraviolet light. It seems that the occasional use of tetracycline for acute illness in the child is most unlikely to produce obvious discoloration of the teeth. When the need exists for more prolonged or frequent medication the advantages of using tetracycline may be so great as to outweigh the of slight tooth pigmentation, and in the more it should be borne in mind that teeth can be crowned effectively if necessary. Royal Dental Hospital of London School of Dental Surgery, University of London, London W.C.2. J. D. MANSON.
disadvantage
extreme cases
SANS TEETH, SANS EYES, SANS TASTE SIR,-In your annotation (March 19) you refer to the problem of labelling dentures for patients in hospital. As Dr. Fine points out (April 9), a denture can easily be marked identifiably when it is being made, and I know of at least 16 methods, although tattooing had not occurred to me. In 30 minutes a dental technician could put a name permanently on any " old denture in one of at least 10 different ways. For the especially fastidious, the name can be written in invisible ink on pink paper; this is processed into a recess in the denture, and only "
1.
Edwin, E., Holten, K., Norum, K. R., Schrumpf, A., Skaug, Acta med. scand. 1965, 177, 689.
O. E.
shows under ultraviolet light. A simple method is now being tried which a nurse in a ward can carry out in less than 5 minutes; the denture can be returned to the patient in about an hour, and remains identifiable for months. This subject is being discussed at the Fourth International meeting in Forensic Medicine in Copenhagen and at the Congress of the Federation Dentaire Internationale at Tel Aviv in the summer. University Dental Hospital and School, WARREN HARVEY Glasgow C.3.
FLUORIDATION AND THE COUNCILLORS SIR,-In his letter (April 30) Dr. Dalzell-Ward admits that the general practice is to limit the permitted amount of food additives or pesticides to 1 % of the maximum no-effects level as ascertained by animal experiments. The maximum noeffects level is naturally somewhat less than the minimum chronic toxic dose. So far we agree. He insinuates, however, that some different rule is applicable when the maximum no-effects level is known for human beings. Will he tell us what that rule is? Until he does so, his argument lacks any factual basis. Dr. Dalzell-Ward then proceeds to suggest that the normal practice should be ignored, because inorganic fluorides are found in water and food. He must know very well that the quantities of fluoride found in foods differ greatly between one food and another. Even in the same kind of food there may be great variations. For example, the dry tea-leaf may contain from a few to several hundred parts per million of fluorine. It follows therefore that the intake of fluorine may vary greatly between one individual and another, and this is a further reason for exercising the greatest caution with regard to proposals for compulsorily increasing the intake of fluorine. Incidentally Dr. Dalzell-Ward implies that the fluorides found in foods are inorganic and are the same as the sodium fluoride and sodium silicofluoride used in water fluoridation. Perhaps he will refer your readers to the scientific evidence for this. It is certainly not true in all cases, if it is in any. In the case I referred to1 it may be true that the proximate cause of death was pneumonia, but Dr. Dalzell-Ward will know very well that terminal pneumonia is the end-result of many chronic diseases, and that this does not displace the observation that the patient was suffering from fluorosis. WINIFRED M. SYKES Hon. secretary, National Pure Water Association.
THE PRESS AND CRIMES OF VIOLENCE SIR,-A causal relation between detailed reporting of violent crimes and the incidence of similar offences remains to be demonstrated. Dr. Richard Fox’s arguments, though plausible and interesting, might possibly prove non sequitur. Moreover, would the proposed reforms outlined in your annotation (April 30) be sufficient ? Surely many current television plays and thousands of paperbacks would be next on the list for censorship, and who knows what further incursions into public liberty might then be introduced. The effect of reporting the current moors murder trial in detail remains to be seen, but I do not recall that the widespread publicity afforded to the Christie murders at the time resulted in further perpetuation of that particular type of horrible crime. Indeed, partial or complete censorship might easily have the opposite effect, thereby stimulating a morbid thirst for knowledge on the part of some persons resulting in distortion and misinterpretation of any information made available for public consumption. Nothing dispels suspicion and ignorance more effectively than good communications. I am opposed to anything prejudicial. o relations between the profession and the Press which might result from restrictive 1.
Sauerbraun, B. J. L., Ryan, C. M., Shaw, J. F. Ann. intern. Med. 1965, 63, 1074.
SERUM-VITAMIN-B12 AND CHLORPROMAZINE SIR,-Dr. Herbert (March 5), in criticising our determinations of serum-vitamin-B12 levels in patients before and after chlorpromazine therapy, suggests " that before the second vitamin-B12 determination the patients had been off large doses of chlorpromazine for a week ". Chlorpromazine treatment was not stopped before the second assay. We have also studied patients treated with high doses of chlorpromazine for years. Their serum-vitamin-B12 values were not low. We have established with reasonable certainty that chlorpromazine in usual doses does not inhibit the growth of Euglena alga. Nor does chlorpromazine suppress the growth of Lactobacillus leichmannii, as shown by Dr. Forshaw and Miss Harwood (March 12). Dr. Herbert implies that our patients were inadequately examined, and states that we did not find structural hsematopoietic damage in a single case. He could easily have seen from our original paper1 how many of our patients with low vitamin-B12 values had hypersegmentation, anisocytosis, and glossitis, and changes of Hb, erythrocyte-sedimentation rate, mean corpuscular haemoglobin, red-cell count, serum-iron, gastric juice, Schilling test, bone-marrow, and neurological status. Good correlation was found with the Schilling test, and some of the other tests were also positive. The vitamin-B12 assay, however, was the only test which allowed us to pick out these patients immediately.
St.
Joseph’s Hospital, Porsgrunn, Norway.
E. EDWIN K. HOLTEN K. R. NORUM A. SCHRUMPF O. E. SKAUG.
TETRACYCLINES AND THE TEETH SiR,—The fact that discoloration of teeth can result from tetracycline medication during the period of crown formation has now been widely reported, and as your leading article (April 23) points out this fact should be borne in mind when choosing an antibiotic for children up to about 7 years old. Nevertheless it seems important to maintain a sense of proportion in this matter and not to prejudice the practitioner against these drugs unjustifiably. During the past 4 years I have used tetracyclines as a bonelabel in the study of bone activity and growth in animals. The level of medication has been similar to that of the 4-5-day therapeutic human adult dose and at this level there have been little if any macroscopic signs of pigmentation, although the label is clearly visible in sections of enamel and dentine when viewed under ultraviolet light. It seems that the occasional use of tetracycline for acute illness in the child is most unlikely to produce obvious discoloration of the teeth. When the need exists for more prolonged or frequent medication the advantages of using tetracycline may be so great as to outweigh the of slight tooth pigmentation, and in the more it should be borne in mind that teeth can be crowned effectively if necessary. Royal Dental Hospital of London School of Dental Surgery, University of London, London W.C.2. J. D. MANSON.
disadvantage
extreme cases
SANS TEETH, SANS EYES, SANS TASTE SIR,-In your annotation (March 19) you refer to the problem of labelling dentures for patients in hospital. As Dr. Fine points out (April 9), a denture can easily be marked identifiably when it is being made, and I know of at least 16 methods, although tattooing had not occurred to me. In 30 minutes a dental technician could put a name permanently on any " old denture in one of at least 10 different ways. For the especially fastidious, the name can be written in invisible ink on pink paper; this is processed into a recess in the denture, and only "
1.
Edwin, E., Holten, K., Norum, K. R., Schrumpf, A., Skaug, Acta med. scand. 1965, 177, 689.
O. E.
shows under ultraviolet light. A simple method is now being tried which a nurse in a ward can carry out in less than 5 minutes; the denture can be returned to the patient in about an hour, and remains identifiable for months. This subject is being discussed at the Fourth International meeting in Forensic Medicine in Copenhagen and at the Congress of the Federation Dentaire Internationale at Tel Aviv in the summer. University Dental Hospital and School, WARREN HARVEY Glasgow C.3.
FLUORIDATION AND THE COUNCILLORS SIR,-In his letter (April 30) Dr. Dalzell-Ward admits that the general practice is to limit the permitted amount of food additives or pesticides to 1 % of the maximum no-effects level as ascertained by animal experiments. The maximum noeffects level is naturally somewhat less than the minimum chronic toxic dose. So far we agree. He insinuates, however, that some different rule is applicable when the maximum no-effects level is known for human beings. Will he tell us what that rule is? Until he does so, his argument lacks any factual basis. Dr. Dalzell-Ward then proceeds to suggest that the normal practice should be ignored, because inorganic fluorides are found in water and food. He must know very well that the quantities of fluoride found in foods differ greatly between one food and another. Even in the same kind of food there may be great variations. For example, the dry tea-leaf may contain from a few to several hundred parts per million of fluorine. It follows therefore that the intake of fluorine may vary greatly between one individual and another, and this is a further reason for exercising the greatest caution with regard to proposals for compulsorily increasing the intake of fluorine. Incidentally Dr. Dalzell-Ward implies that the fluorides found in foods are inorganic and are the same as the sodium fluoride and sodium silicofluoride used in water fluoridation. Perhaps he will refer your readers to the scientific evidence for this. It is certainly not true in all cases, if it is in any. In the case I referred to1 it may be true that the proximate cause of death was pneumonia, but Dr. Dalzell-Ward will know very well that terminal pneumonia is the end-result of many chronic diseases, and that this does not displace the observation that the patient was suffering from fluorosis. WINIFRED M. SYKES Hon. secretary, National Pure Water Association.
THE PRESS AND CRIMES OF VIOLENCE SIR,-A causal relation between detailed reporting of violent crimes and the incidence of similar offences remains to be demonstrated. Dr. Richard Fox’s arguments, though plausible and interesting, might possibly prove non sequitur. Moreover, would the proposed reforms outlined in your annotation (April 30) be sufficient ? Surely many current television plays and thousands of paperbacks would be next on the list for censorship, and who knows what further incursions into public liberty might then be introduced. The effect of reporting the current moors murder trial in detail remains to be seen, but I do not recall that the widespread publicity afforded to the Christie murders at the time resulted in further perpetuation of that particular type of horrible crime. Indeed, partial or complete censorship might easily have the opposite effect, thereby stimulating a morbid thirst for knowledge on the part of some persons resulting in distortion and misinterpretation of any information made available for public consumption. Nothing dispels suspicion and ignorance more effectively than good communications. I am opposed to anything prejudicial. o relations between the profession and the Press which might result from restrictive 1.
Sauerbraun, B. J. L., Ryan, C. M., Shaw, J. F. Ann. intern. Med. 1965, 63, 1074.